SAFETY AND INDUSTRIAL HYGIENE HAZARD … of... · Assemble the materials below for review while...

Installation:

Organization:

Building #:Similar Exposure Assessors:

Assemble the materials below for review while completing the Safety and Industrial Hygiene Hazard Risk Assessment.

1) Previous IH/Safety Inspections2) Local Written Hazard Control Programs, Procedures and Plans3) Injury/Illness Logs4) Accident/Incident/Near-Miss Investigation Reports or Summaries5) Employee Hazard Reports6) Completed Job Hazard Analysis of Job Safety Analysis7) Employee Hazard Reports6) Health Hazard Inventory or Industrial Hygiene Implementation Plan

SAFETY AND INDUSTRIAL HYGIENE HAZARD ASSESSMENT

Hard copies of this document may not be the current version. Refer to the “I Am The Key” to verify the current version

Answer the questions in the highlighted spaces below to determine which Sections of the Safety and Industrial Hygiene Hazard Assessment will need completed. Please note that some Sections are mandatory for all locations (as indicated below). Based on the answers below either entire Sections or Sub-sections of the review may not need completed.

Is Section Applicable for the Location Being Assessed (Y or N)?

1. Safety Management Program and Required Postings (MP) Y

This section is required for all locations

2. Tools and Equipment and Lockout/Tagout (TE) Y a) Does this location have compressed gas cylinder storage? y b) Does this location include a welding, cutting or braising operation? y c) Does this location include a metal shop, wood shop, fitting shop or other machine shop operation? y d) Are bench grinders or portable grinders used at this location? y e) Are ladders used at this location? y f) Are hand tools or portable power tools used by employees at this location? y g) Does this location have electrical service? y h) Does this location include energized equipment requiring preventative maintenance or failure maintenance? y

3. Walking and Working Surfaces and Confined Spaces (WW) Y

Subsections of this Section are required for all locations (Elevated Surfaces and Walking & Working Surfaces)

a) Does this location have confined spaces or permit required confined spaces?

4. Personal Protective Equipment and Fall Protection (PPE) y

Subsections of this Section are required for all locations (PPE Evaluation and General) a) Do employees perform elevated work at least 4 feet off the floor without a standard railing? b) Do employees work with any chemicals at this location? c) Does this location include a welding, cutting or brazing operation?

e) Are stock pickers, booms, or other elevating powered industrial trucks operated at this location? f) Are propane tanks, hydrogen fuel cells or other fueling operations performed at this location? g) Are there noisy work areas at this location? h) Do employees work on energized surfaces?

5. Powered Industrial Trucks and Racking (PIT) y a) Are Powered Industrial Trucks operated at this location? b) Is material stored in steel racking units?

6. Trailer Control (TC) y a) Does this location have a receiving or shipping operation?

7. Fire Protection and Fire Prevention (FS) Y This section is required for all locations

8. Life Safety and Emergency Procedures (LS) Y

This section is required for all locations

9. Occupational Health (OH) Y Subsections of this Section are required for all locations (General, Hazard Communication, Bloodborne y Pathogens and Eyewash & Emergency Shower)

k) Is poor indoor air quality (IAQ) a concern at this location?

10. Asbestos Management and Exposure Prevention (ACM) Y a) Were facilities at this location built before 1980 and are asbestos containing materials present?11. Process Safety Management (PSM) y a) Does this location assemble, manufacture or DEMIL ordinance? y b) Does this location include a covered process as defined by 29 CFR 1910.119? y12. Crane and Hoist (CRN) Y a) Are cranes and hoists used at this location?

d) Does this location include a metal shop, wood shop, fitting shop or other machine shop operation?

b) Do employees at this location perform abrasive blasting, abrasive machining, bagging and handling of dry materials, crushing or grinding, dry mixing, wet grinding, facility renovation work or work on surfaces covered lead based paint?

c) Do employees at this location work with Drying ovens, gas furnaces or oven heating operations, material handling warehousing with (PIT), open surface tanks, or complete gas or arc welding ?

d) Do employees at this location work with open surface tanks, machine or metal shops, drawing operations, wet grinding, wet blasting or wet mixing operations?e) Do employees at this location complete gas or arc welding?f) Do employees at this location work with gas furnaces, microwave and radio frequency heating operations, machine or metal shops, wood shops, engine rooms, flight line operations, vehicle repair and tire changing stations?

g) Do employees at this location work in cold or hot environemnts for extended periods of time to include (outside environment, steam rooms, microwave and radio frequency heating operations, etc…)

a) Do employees at this location work with open surface tanks, spray paint operations, coating operations, liquid pouring stations, vapor degreassing units, wet mixing stations, or complete gas or electric arc welding?

h) Do employees at this location work with radioactive materials?

i) Do employees at this location perform arc welding, electron beam welding or work with class 2, 3, and 4 lasers? j) Do employees at this location work in machine shops, perform bagging & handling of dry materials, plating operations, or work at vapor degreasing stations.

Assessment Section

b) Are mobile cranes and hoists used at this location?13. Ergonomics (ERG) Y a) Is there a history of employee strains, sprains or musculoskeletal disorders? b) Do tasks performed at this location require: 1. frequent or repetitive lifting? 2. manual material handling as a primary job function? 3. computer terminal operation as a primary job function? 4. long periods of standing or sitting? 5. bending, stretching, or awkward repetitive motions?

For the Sections 1-13 answered "Yes", please go to the applicable tab to complete the assessment for that Section. If a particular question does not apply to the site, leave the columns blank.

Enter "Y" or "N". If No,

enter a Corrective Action in

highlighted column

Enter Risk Assessment Code (RAC) Score 1-5

Hazard Description (Be Specific as to Location, Operation, Task and Type of

Hazard)

Action Required (Identify Specific

Actions to quantify risk and mitigate: e.g. complete

personal

Action Completion

Date

29 CFR 1960.6 thru 26Safety Instruction

The local safety instruction and one book can be located by the safety manager

The safety policy statement is signed by the current director or commanding officerand posted. The safety mission statement is signed by the current director or commanding officerand posted

Safety Goals Safety goals and objectives have been created, up-to-date, and are posted.

Management ParticipationThere is at least one means to verify management participation

Area inspections are being completed and management is involved in the process

There is accountability processes in place to ensure management participation

Safety Awareness Bulletin BoardThe DOD 2272 Poster that lists employees' responsibilities to safety and health is posted and employees know where to find it.A safety bulletin board is organized and kept up to date

Required PostingsThe required OSHA workplace poster is displayed in a prominent location where allemployees are likely to see it Workers' compensation poster is posted in a common areaAn updated emergency telephone list is available with the last revision date annotatedat the bottom of the listing

Hazard AssessmentAnnual Safety Inspections are completed and final reports are maintained Organizational HQ safety personnel contact information is available

Accident/Incident ReviewsAccident/Incident reviews are conducted for all incidents and near missesCorrective action plans are developed and documented on the incident and near missreview form

Contractor Safety Program

It is procedure that all contractors receive the same safety and health training that regular employees receive. This training includes: the identified major hazards onsite, what to do when a hazard is present onsite, emergency information, etc.

A contractors pre-selection process or scalable oversight program is in useContractor safety training process is in place and trackedContractor compliance verification process is in place

Baseline Score %: 0%Initial Number of Corrections Required: 0 RAC 1 => Critical Risk

Number of Corrections Made: 0 RAC 2 => Serious Risk

Outstanding Corrections: 0 RAC 3 => Moderate Risk

Score After Corrections Made: 0% RAC 4 => Minor RiskRAC 5 => Negligible Risk

Corrections Required

Corrections Made

RAC 1 0 0RAC 2 0 0RAC 3 0 0RAC 4 0 0RAC 5 0 0

0 0

Safety Management Program and Required Postings

ASSESSMENT CRITERIA (complete sections that are not shaded)

Corrections Made


0

0.2

0.4

0.6

0.8

1

RAC 1 RAC 2 RAC 3 RAC 4 RAC 5

0 0 0 0 0

0 0 0 0 0

INTERPERETIVE GUIDANCE DOCUMENT (IDG) Environmental, Safety and Occupational Health Management systemDLA Strategic Materials

Version: June 2011

CautionHard copies of this document may not be the current version. Refer to the “I AM The Key” link to verify the current version.



applicable column


based on the DoD 6055.1 Protocol for Safety

Hazards.

Hazard Description 1. Contact with electrical equipment

2. Contact with temperature extremes3. Fall from elevation4. Fall on same level

5. Struck against6. Struck by

7. Caught in, under, or between8. Rubbed or abraded

9. Physical/bodily reaction(Be Specific as to Location, Operation, Task

and Type of Hazard)


Actions to quantify risk and mitigate: e.g.

complete personal sampling, complete a

JHA, develop a written plan, etc)

Action Completion

Date

Compressors, Gas Cylinders and Compressed Air Equipment (complete if answered Yes to question 2a on pre-assessment questionnaire)

29 CFR 1910.101 N/AGas cylinders are legibly marked to clearly identify the gas contained All empty gas cylinders are being stored and separated from full containersAll gas cylinders are being stored in the up-right position using with the wall supported storage techniquesor the nested storage techniquesGas cylinders are stored in areas where they will not be damaged by passing or falling objects or subject totampering by unauthorized personnelSmoking or the use of open flame is prohibited within 25 ft of an area with flammable gasesValve protectors are always placed on cylinders when the cylinders are not in use or connected

Compressors are equipped with a pressure relief valve and pressure gauges or nozzles regulated to 30psi

29 CFR 1926.350 Gas cylinders are being placed where they cannot become part of an electrical circuit Gas cylinders are stored in areas which are protected from external heat sources such as flames, intenseradiant heat, electrical arcs, or high temperature linesGas cylinders are transported in a manner to prevent them from creating a hazard by tipping, falling, orrollingCylinders are kept away from stairways or gang waysValve is closed off before a cylinder is moved, when the cylinder is empty, and at the completion of eachjobFlammable and oxidizing gases must be stored at least 20 ft apart from each other

NFPA 55-2.2 thru 6-7Compressed gas cylinders are stored in a well-ventilated area

Gas cylinders are being stored out of direct sunlight and away from sources of heat and ignition;temperatures not exceeding 125 degrees Fahrenheit

CGA 3.3.3Spare Oxygen and Acetylene tanks separated by at least 20 feet

Signs are posted to warn of the automatic starting feature of the compressor

Welding, Cutting and Braising (complete if answered Yes to question 2b on pre-assessment questionnaire) 29 CFR 1910.252This location has a written hot work program and hot work permits are completed before work commences.

Only authorized employees permitted to use welding, cutting, or brazing equipmentOnly approved apparatus (torches, regulators, pressure-rendering valves, acetylene generators, manifolds)are usedFlammable materials are removed from the welding area or are protected before hotwork commences.

A fire watch is maintained during and after hot work by a trained person as required by 29 CFR 1910.252(30 minutes after work ceases)

29 CFR 1910.253Hoses gauges and connectors are inspected before each use.

29 CFR 1910.254Open circuit (no-load) voltage of arc welding and cutting machines as low as possible and not in excess ofthe recommended limitsGrounding of the machine frame and safety ground connections of portable machines are checkedperiodicallyMachine Guarding and Safety Features (complete if answered Yes to question 2c on pre-assessment questionnaire) 29 CFR 1910.212Employees are protected from points of operation, ingoing nip points, rotating parts, flying chips or sparks by two hand controls, pull backs, interlocks, light curtains, or other protective devices. (Is there a machine guarding hazard?)Machine guards for conveyor equipment are secure and arranged so that they do not offer a hazard intheir use 29 CFR 1910.219Pulleys and belts that are within seven feet of the floor or working level are properly guarded

29 CFR 1910.122Fan blades are protected with a guard having openings no larger that 1/2 inch, when operating within sevenfeet of the floor 29 CFR 1910.144All emergency stop buttons are colored redThis location has a written policy regarding machine guarding.Machine guards are not disabled or bypassed during use.

Safe Ladder Use (complete if answered Yes to question 2e on pre-assessment questionnaire) 29 CFR 1910.25, 29 CFR 1910.26, & 29 CFR 1910.27Ladder inspections are completed prior to each usageLadders are maintained in good condition; joints between steps and side rails tight; all hardware and fittingssecurely attached and movable parts operating freely without binding or undue playManufacturer's labels and warnings are present and visible on the ladder.The site has a written ladder safety programDo not use the top step/rung of a ladder as a step/rung unless it was designed for that purposeDo not exceed the maximum load rating of a ladder (take into account weight of equipment and tools)

Non-slip safety feet provided on each ladderWhen ladders are in use, safe operating procedures have been created and are being followed such as,having three points of contact with the ladder at all times.

Abrasive Wheel Grinder (complete if answered Yes to question 2d on pre-assessment questionnaire) 29 CFR 1910.215Work rest is used and kept adjusted to within 1/8 inch of the wheelThe adjustable tongue on the topside of the grinder is used and kept adjusted to within 1/4 inch of the wheel

Side guards cover the spindle, nut, and flange and 75% of the wheel diameterThe Maximum RPM rating on the abrasive wheel is compatible with the RPM rating of the grinder motor

Abrasive wheels are used for the work material for which they are designed forAbrasive wheels are ring tested before they are mountedPedistal grinders are bolted to the floor. Bench grinders are secured.

Hand Tools, Portable Power Operated Tools and Equipment (complete if answered Yes to question 2f on pre-assessment questionnaire) 29 CFR 1910.241, 242, 243, & 244The site has a written tool safety program for both hand tools and power tools as appropriate.Tools are only used for their intended purpose.Employees are trained on the proper use of hand toolsNo broken or fractured handles on hammers, axes and, similar equipmentAppropriate handles are used on all chisels, files, etc.No worn or bent wrenches are being usedHand tools such as chisels, punches, etc. which develop a mushroomed head have been replaced

Power tools have the appropriate shields, guards, or attachments recommended by the manufacturer

Employees using power-actuated tools are trained in their use and carry a valid operators card. (Examplesare any tool requiring a powered charge)Power actuated tools are stored in their own locked container when not in use

Electrical Safe Work Practices (complete if answered Yes to question 2g on pre-assessment questionnaire) 29 CFR 1910.137 & 29 CFR 1910.332 thru 335The location has a written electrical safety program.CGFI outlets are used near water sources and in wet/damp areas.36 inch clearance is maintained around electrical panels.Portable electrical tools and equipment are grounded or double insulatedElectrical appliances such as vacuum cleaners, polishers, pipe bending machines, grinding wheels, etc.are groundedExtension cords have a grounding conductorExtension cords are used only for temporary service (No more than 90 days)Power-strips and extension cords are not "dasiy chained"Fixed or permanently mounted powered tools are connected to permanent wiringNo exposed wiring and cords with frayed or deteriorated insulationFlexible cords and cables are free of splices or tapsFiberglass ladders are available and metal ladders are prohibited where the ladder or person using theladder could come into contact with energized partsEnergized parts of electrical circuits and equipment are guarded against accidental contact by approvedcabinets or enclosuresAll unused openings (including conduit knockouts) in electrical enclosures and fittings are closed withappropriate covers, plugs, or platesElectrical enclosures such as switches, receptacles, junction boxes, etc. are provided with tight fitting coverplatesAll electrical equipment used in the truck bay service pit areas are classified as Class 1 Division 1

Lock Out/Tag Out Program (complete if answered Yes to question 2h on pre-assessment questionnaire) 29 CFR 1910.147This Location has a written lockout/tagout program and procedures.Authorized and qualified employees are provided with individually keyed personal safety locks.Hot-tap work is never done except when essential to keep the service in operation; it is impractical to shutdown the service and a Hot-tap permitting system is used. Lockout locks are only being used to lock out equipment and separate locks are administered to employeesto lock-up items such as, cabinets, lockers, and toolboxes. Procedures require employees to maintain control of their keys while their have safety locks are in use.

Specific procedures available to identify and neutralize all sources of kinetic and potential energy includingelectrical circuits, hydraulic energy, gravity system, spring energy, and pneumatic systems.

Only the employee who places the lock shall remove itOnly the employee exposed to the hazard places or removes the safety lock.The safety of the lockout is checked by attempting to start up after ensuring no one is exposed"DO NOT OPERATE" signs or tags and padlocks are available for any reasonable foreseeable repairemergencyPeriodic inspections are completed






Corrections Made


0 0

Tools and Equipment and Lockout / Tagout


Corrections Made

Corrections Required0

0.2

0.4

0.6

0.8

1

RAC 1RAC 2

RAC 3RAC 4

RAC 5

0 0

0 0

0

0 0 0

0 0


Version: June 2011




applicable column

Enter Risk Assessment Code (RAC) Score 1-5 based on the DoD 6055.1

Protocol for Safety

Hazards.





9. Physical/bodily reaction(Be Specific as to Location, Operation,

Task and Type of Hazard)


Actions to quantify risk and mitigate:

e.g. complete personal sampling,

complete a JHA, develop a written

plan, etc)

Action Completion

Date

Elevated Surfaces (complete this sub-section) 29 CFR 1910.67Signs are posted, where appropriate, showing the elevated surface load capacities

Surfaces elevated more than 48 inches above the floor or ground are provided with standard guard rails

Permanent means of access and egress are provided to elevated storage and work surfacesAdequate head room is availableMaterial on elevated surfaces is piled, stacked, or racked in a manner to prevent tipping, falling, collapsing,rolling, or spreading

Walking and Working Surfaces (complete this sub-section)

29 CFR 1910.22, 23, 24 & 28All hatchways, wall, and floor openings are guardedFixed stairways have a minimum width of 22 inchesAll fixed stairways with a width of 88 inches or more are provided with a center stair railStair treads are non-slip and are in good repair.Walkways, stairways, and aisle ways are free of obstructions.

Confined Space Program (complete if answered Yes to question 3a on pre-assessment questionnaire) 29 CFR 1910.146This location has a confined space entry program and permitting system.All employees entering confined spaces have had the proper Confined Space Training. Evaluation of all confined spaces has been completedIt is normal practice that prior to entering a confined space Industrial Hygiene Sampling is conducted by aqualified person to ensure they all safety and health measures are being taken

An inventory of all the confined spaces is maintained

All permit required confined spaces have been identified and are properly labeled

Standard operating procedures for notification of entry, contaminant quantification, emergency procedures,and / or master entry plans (MEP) are executed

The signage is accurate based on the completed evaluation






Corrections Made


0 0

Walking and Working Surfaces and Confined Spaces


Corrections Made


0.5

1

RAC 1RAC 2

RAC 3RAC 4

RAC 5

0 0 0

0 0

0 0 0

0 0


Version: June 2011




applicable column


based on the DoD 6055.1 Protocol for

Health Hazards.

Hazard Description: CHEM, BIO, PHY - along with a detailed description of the operation and exposure location

(Identify if sampling is needed)

Action Required (Identify Specific Actions to

quantify risk and mitigate: e.g. complete personal

sampling, complete a JHA, develop a written plan, etc)

Action Completion

Date

PPE Evaluation (complete this sub-section)

29 CFR 1910.132 thru 139There is a written PPE program

All employees are trained on proper PPE usage for their individual work areas

Tasks have been evaluated to identify necessary PPE

All damaged PPE is taken out of service immediately

There is a written procedure in place for damaged PPE

This location has a comprehensive Industrial Hygiene Implementation Plan.

The facility has assessed potential worker exposures to toxic and hazardous substances.

The facility has been assessed for potential worker exposures to physical agents such as noise, ionizing radiation, non-ionizing radiation, heat or cold stress.

There are policies, procedures, or methods in place to quantify employee exposures to hazardous materials and physical agents in the workplace including sampling devices, recordkeeping provisions, industrial hygiene equipment upkeep, and calibration schedules.

Sampling methods are consistent with OSHA requirements or generally accepted NIOSH, ASTM, or DoD-specific procedures. Reports include references to sampling device, calibration and test equipment, sample handling, and documentation or field notes.

Exposure evaluations are performed by persons having specific training in exposure assessment.

Exposure monitoring including measurement of air contaminant levels for particular substances is conducted routinely.

Sample analysis is performed by a laboratory accredited by the American Industrial Hygiene Association (AIHA).

Employees are informed of exposure monitoring results.

Worker exposures are maintained within established limits for physical and chemical agents, e.g., OSHA PELs, ACGIH TLVs, or DoD-specific occupational exposure limits.There are methods in place to determine the cause(s) of employee overexposures to hazardous materials, if discovered.

Limited access regulated areas are designated.

Required Personal protective equipment is made available to employees.Training programs are in place to ensure workers are aware of hazardous materials in the workplace and training is documented..A medical surveillance program is in place, including pre-employment exams and periodic follow-up exams and compound specific exams.Records of worker exposure monitoring and exposures are maintained in accordance with regulatory requirements.

There are methods in place to ensure compliance with compound-specific work practice and administrative control programs.

Fall Protection (complete if answered Yes to question 4a on pre-assessment questionnaire) 29 CFR 1926.500 thru 503This location has a written fall protection program.

Every employees is issued their own fall protection equipment

Fall Protection Personal Protective Equipment is available and in good condition

All fall protection is tested annually by a qualified individual to ensure that it is operable

Fall protection equipment is inspected before each use and taken out of service if found to be damaged.

Equipment is taken out of service immediately after restraining a fall.

Employees are using fall protection equipment when operating scissor lifts, powered basket trucks, orother equipment for completing elevated work 4 or more feet above the floor without a standard railing

Anchor points are available overhead

Face shields and appropriate safety glasses available and used

When operating abrasive wheels and other rotating equipment, employees are not wearing loose clothingor long sleeves that could potentially get caught in the equipment.

Stock picker, boom lift or scissors lift operators (complete if answered Yes to question 4e on pre-assessment questionnaire)

nnn

29 CFR 1910.178 N

Approved body harness, approved shock absorbing lanyard, and approved anchor points available andused

Electrical Safety PPE (complete if answered Yes to question 4h on pre-assessment questionnaire) 29 CFR 1910.335

When working where there is a possible exposure to arc-flash, personnel are trained in accordance with NFPA-70e and use PPE specifically designed to protect against arc flash is provided and used.


Number of Corrections Made: 0 RAC 2 => Serious RiskOutstanding Corrections: 0 RAC 3 => Moderate Risk



Corrections Made


0 0

Personal Protective Equipment and Fall Protection


Corrections Made


0.5

1

RAC 1RAC 2

RAC 3RAC 4

RAC 5

0 0 0

0 0

0 0 0

0 0


Version: June 2011




applicable column

Enter Risk Assessment Code (RAC) Score 1-5 based on the DoD 6055.1

Protocol for Health

Hazards. (This code

is to be







Action Required (Identify Specific Actions to quantify

risk and mitigate: e.g. complete personal

sampling, complete a JHA, develop a written plan, etc)

Action Completion

DatePowered Industrial Truck B3Training (complete if answered Yes to question 5a on pre-assessment questionnaire) 29 CFR 1910.178This location has a MHE safety policy / program

There is a master list of licensed operators

Powered equipment license history is maintained

Equipment certification/re-certification forms are completed

All trucks have a lifting capacity adequate for the work being performed

Retraining is required every 3 years or after a mishap or near miss event

This location has an MHE operator training program that provides adequate training time on each piece of equipment the operator will use to complete their job.

Visiting employees are trained and licensed at this location before operating Material Handling Equipment.

Powered Equipment Operations (complete if answered Yes to question 5a on pre-assessment questionnaire)Only trained licensed operators are operating powered equipment

Each truck has a warning horn, whistle, or other device which can be clearly heard above the normal noise where the lift truck is operated

Powered Equipment Operation Observations (complete if answered Yes to question 5a on pre-assessment questionnaire)Power equipment operators travel in a single file with a minimum of three (3) lengths between equipment unless passing in the opposite directionSeat belts are being worn by all powered industrial truck operators

All industrial vehicle drivers are driving equipment at a safe speed

Main aisles have the right of way

Operators slow down and honk when approaching main and cross aisles

Operators drive into main aisle with either forks or basket trailing

Operators look in the direction of travel as well as each side before moving the equipment

Operators keep forks no more than three (3) inches off the floor when the forklift is in transit

No one is walking close to the equipment while it is in motion

Operators stop at all fire doors, proceed with caution, and watch for other traffic

Operators keep hands and feet within the confines of the equipment

Operators keep hands on the steering and operating controls while the equipment is in motion

Operators signal (ex: calling "20 feet") before raising loads

When a powered industrial truck is left unattended, load engaging means shall be fully lowered, controls shall be neutralized, power shall be shut off, and brakes set

Pre-use inspection forms are properly completed and available on the equipment

Pre-use inspection forms are kept on file for three (3) months

Steel Racking (complete if answered Yes to question 5b on pre-assessment questionnaire) ANSI MH 16.1 -2008-1.4 thru 8.4Racks are secured to the floor

All racks have the load limits posted on each shelf

Protective barriers are installed to prevent damage

Racking is free of physical damage

Safety pins are securely fixed on both ends of the cross beam

All modifications to the shelves have been approved by the manufacturer

Rack welds free of cracks and rust






Corrections Made


0 0

Powered Industrial Trucks and Racking


Corrections Made


0.5

1

RAC 1RAC 2

RAC 3RAC 4

RAC 5

0 0 0

0 0

0 0 0

0 0


Version: June 2011




applicable column



Safety Hazards.








Actions to quantify risk and mitigate: e.g. complete personal

sampling, complete a JHA, develop a written

plan, etc)

Action Completion

Date

Receiving Area (complete if answered Yes to question 6a on pre-assessment questionnaire) 29 CFR 1910.178Documented trailer control procedures are implemented to prevent pull always

Brakes are being set and wheel blocks are kept in place to prevent movement of trucks, trailers, or railroad cars while loading or unloading vehicles.

Fixed jacks are being used where necessary in order to support semitrailers while loading and unloading when the trailer is not attached to a tractor

It is proper procedure for the flooring of trucks, trailers, and railroad cars to be checked for breaks and weaknesses before they are driven onto by fork trucks or other vehicles used for loading and unloading items.

Powered industrial truck trailer entry procedures are being followed

Proper call out procedures are being followedThe receiving dock is in good repair.Shipping Area (complete if answered Yes to question 6a on pre-assessment questionnaire)Proper call out procedures are being followed

A Trailer Movement Log or equivalent is being used by the yard driver and the Unload/door Sheet is being used by the Manager, Supervisor, or designated employee.

The shipping dock is in good repair.Portable loading ramps are in good operating condition and are inspected before each use.

Auditing (complete if answered Yes to question 6a on pre-assessment questionnaire) This Location has trailer control procedures.

Trailer control procedures are audited at least annually

Dock Lights (Red and Green) (complete if answered Yes to question 6a on pre-assessment questionnaire) Inspections are conducted weekly

Follow-ups are completed on all noted discrepancies






Corrections Made


0 0

Total Inspection

Criteria00000

Trailer Control


Corrections Made


0.5

1

RAC 1RAC 2

RAC 3RAC 4

RAC 5

0 0 0

0 0

0 0 0

0 0


Version: June 2011




applicable column



Safety Hazards.





9. Physical/bodily reaction(Be Specific as to Location, Operation, Task

and Type of Hazard)

Action Required (Identify Specific Actions to quantify risk and

mitigate: e.g. complete personal sampling,

complete a JHA, develop a written plan, etc)

Action Completion

Date

Sprinkler System 29 CFR 1910.159 & NFPA 13Sprinkler heads are unobstructed (18" clearance)

Sprinkler heads are protected against damage by system location or with metal guards.

Fire system valves are locked in the "open" position

Tests and inspections are completed. There are quarterly drain tests and an annual system inspection. All discrepancies have been addressed

Verify that the most recent inspection recommendations have been corrected

Hazardous Waste 29 CFR 1910.120This location has a hazardous waste storage and disposal plan.

Containers are closed and in good condition and the area is clean

Incompatible wastes are kept separate

Barrels are grounded or bonded

This location has a spill containment plan.

Spill containment pallets are in use

Containers are checked for leaks at least weekly.

Record keeping procedures are current

Container markers and labeling are visible and legible

Necessary emergency equipment including fire extinguishers, eyewash / deluge shower stations and spill clean-up materials are available.There is at least one employee available at this location or on call with the responsibility for coordinating all applicable emergency response measures.

Pallet Storage NFPA 13 & NFPA 231Stacks of pallets are no more than 12 pallets high

No inside bulk storage of pallets unless the building is protected by ESFR sprinklers

Outside bulk storage of pallets should be 50 feet from the building

Flammable and Combustible Materials

29 CFR 1910.106 & 107This location has a flammable materials safety policy for storage and handling.

Bulk drums of flammable liquids are grounded and bonded while dispensing.

Flammable storage cabinets are labeled "Flammable - Keep Fire Away"

Flammable storage cabinets are not used to store more than their rated capacity.

Sufficient ventilation is provided to prohibit the build-up of flammable gasses.

All flammable and combustible materials are labeled with their proper name and warnings

Combustible scrap, debris, and waste materials (oily rags, etc.) are stored in covered metal receptacles and emptied frequentlyFlammable liquids are kept in approved containers when not in use (e.g. Gasoline parts cleaning tanks, pans, etc.) or in cabinets (e.g. smaller containers such as aerosol cans, etc.)

Parts washer, including fusible link, is in good working order and the lid is able to close

Solvents and flammable wastes are kept in approved covered containers until removed from this location.No smoking rules are rigorously enforced in areas where flammable materials are stored.The site’s written fire protection program includes considerations for spray paint operationsThere are "No Smoking" signs posted in spray paint areas, paint rooms, paint booths and paint storage areas.Belts and pulleys inside the booth are fully enclosed, if present.Covered metal waste cans are used for paint soaked waste.Electric motors for exhaust fans are placed outside the booth.Lighting fixtures for paint booths are locatedoutside the booth with interior light being provided through clear selaed panels.Paint booth floors, walls, baffles are noncombustible and easy to clean.Paint booths are constructed of substantial materials - metal, masonry, or other noncombustible materials.

Spray painting operations are conducted inspray paint rooms with appropriate exhaust.

Ventilation ducts have access doors to allow cleaning.The spray area is located at least 20 feet from flames, sparks, operating electrical motors, and other ignition sources.The pray area is free of hot surfaces.The spray are is kept clean of combustible residue.

Hot Works Permit Procedure 29 CFR 1910. 252 & NFPA 51Before cutting and welding is permitted,the area is inspected by the individual responsible for authorizing cutting and welding operations. He/she must designate precautions to be followed in granting authorization to proceed, preferably in the form of a Hot Work Permit

Hot Work Permits are only being issued to areas that have been proven to be made fire safe by moving all items such as combustibles and other potential ignition sources

Hot Works Permits and log procedures are used properly and filed (retained for 12 months)Fire watch training is held annually and includes fire extinguisher use and fire watch guidelines

Housekeeping 29 CFR 1910.22 & 176Good housekeeping standards maintained

Mats, grating, etc. are used where drainage is needed.

Spills are cleaned up immediatelyAn adequate cleaning schedule is maintained to prevent the accumulation of dusts or other contaminants.Aisles are free from storage of any items


Number of Corrections Made: 0 RAC 2 => Serious RiskOutstanding Corrections: 0 RAC 3 => Moderate Risk



Corrections Made


0 0

Fire Protection System and Fire Prevention


Corrections Made


0.5

1

RAC 1RAC 2

RAC 3RAC 4

RAC 5

0 0

0 0

0

0 0 0

0 0


Version: June 2011




applicable column



Safety Hazards.







e.g. complete personal sampling,

complete a JHA, develop a written

plan, etc)

Action Completion

Date

29 CFR 1910.37 thru 39Emergency Procedures Site specific written procedures are maintained and updated. When written procedures are updated all employees are notified

The facility has a fire prevention plan that includes all information in the OSHA Standard: 29 CFR 1910.39.

At least one (1) fire drill per area has been conducted in the previous year

The facility is involved with the installation's Emergency Planning Committee including being part of the Emergency Plan

Emergency Evacuation Plans Plans are posted throughout the facility

"You are Here" designations are used and the plans are easily understood

The maps are coded for different plans (Fire, Severe Weather, etc.)

The alarm system is functioning properly

Emergency Exits

Exits are readily accessible at all times.Exits are free from obstructions, inside and outside.Exits are arranged so there is not travel towards or adjacent to any area of high hazard.Exit routes are shielded from high hazard areas.

Exit routes are clearly marked to provide a line of sight to the exit.

Every identified exit leads directly outside or to a walkway, refuge area, public way, or open space with access to the outside

All identified exits are unlocked

The width of the exit route is 28 inches or greater.Doors along the means of egress open in the direction of travel and are equipped with panic hardware.Revolving, sliding, or overhead doors are not considered or used as a required exit door.Exit route doors are designed that no failure of a device or alarm will restrice emergency use of exit routes

Illuminated exit signs are provided with the word "EXIT" in lettering at least five (5) inches high and 1/2 inch wide

Firee doors remain closed at all times.Every exit sign is suitably illuminated by a reliable light source of at least 5 foot-candles.Each identified exit route is adequately lighted so that an employee with normal vision can see along the exit route.Doors, passageways, or stairways that neither lead to exits or access to exits and which could be mistaken for exits, are appropriately marked "Not An Exit", "Electrical Closet", "Store Room" etc.Exit routes are substantively level or differences in elevation are negotiated by ramps or stairs.Exit stairs that continue beyond the floor of discharge are interrupted at the floor of discharge by partitions, doors or other means. Exit doors that that open directly into the street or other aera where traffic may be encountered are provided with barriers and warning signs to prevent employees from stepping into the path of traffic.

Emergency Lighting

Emergency light sources are tested and functioning properly

Inspections are completed and documented, and there are follow-ups for any noted discrepanciesThe emergency generators are tested as per policy

Fire Wall Doors Inspected per guidelines






Corrections Made


0 0

Life Safety and Emergency Procedures


0 2

0.4

0.6

0.8

1

0 0

0 0 0

0


Version: June 2011


Corrections Made


0.2

RAC 1RAC 2

RAC 3RAC 4

RAC 5

0 0 0

0 0

0

0


Version: June 2011



applicable column

Enter Risk Assessment Code (RAC) Score 1-5 based on the DoD 6055.1 Protocol for Health

Hazards. (This code is to be used in prioritizing a sampling

strategy. The code can then adjusted based on assessment

findings).

Hazard Description: CHEM, BIO, PHY - along with a detailed

description of the operation and exposure location (Identify if

sampling is needed)

Action Required (Identify Specific Actions to

quantify risk and mitigate: e.g. complete personal sampling, complete a JHA, develop a written

plan, etc)

Action Completion

Date

Hazard Communication (complete this sub-section)

29 CFR 1910.1200

The facility has a written Hazard Communication Program in place; the program includes a list of hazardous chemicals present in the workplace, methods used to inform employees of the hazards of nonroutine tasks, methods used to inform contractors of hazards, description of requirements for container labeling, MSDSs, and employee training and how the requirements will be met.

Each container of hazardous material, including piping in the workplace, is labeled with the identity of the hazardous chemical and appropriate hazard warnings.

A written procedure requires review of new chemicals prior to purchase.

MSDSs are available for each hazardous chemical produced, imported, or used in the workplace.

Employees are trained on the written Hazard Communication Program; training includes methods used to detect presence or release of a hazardous chemical and measures employees can take to protect themselves from hazards.

An inventory of chemicals used at this facility is maintained. This includes hazardous materials created by processes at this location (example: welding fumes).

An employee is designated for compiling MSDS's, labeling containers, and conducting employee training.

Material Safety Data Sheets are available to all employees.Bulk samples for potential hazards as identified from the chemical inventory have been collected for analysis and results reviewed.

Area samples and /or personal dosimetry has been completed for potential chemical hazards.Appropriate engineering controls (e.g. Ventilation Systems, Enclosures, Product Substitution) have been applied.

Administrative controls (e.g. Worker Rotation, Standard Operating Procedures, Signage) have been applied when only when engineering controls are not feasible.

Personal Protective Equipment is used only after appropriate engineering controls and administrative controls have been evaluated.

General Ventilation (complete this sub-section) 29 CFR 1910.94Engineering controls are used for the control of hazards.

There are methods in place to ensure engineering controls are maintained; documentation of inspection and maintenance operations are maintained.

Indoor Air Quality (IAQ) (complete if answered Yes to question 9k on pre-assessment questionnaire) ACGIH Industrial Ventilation Manuel & ASHRAE IAQ Quality GuideEmployee exposures to IAQ contaminants have been surveyed at this location to include:

Heating, ventilation, and air conditioning (HVAC) systems are maintained and service records are available.Equipment that operates by combustion are on a preventative maintenance schedule.Sources of chemical, or microbiological contaminants are identified and removed from the work area. Contaminants include Carbon Dioxide, Volatile Organic Compounds (VOC), Molds, Ozone, and microbial contamination.

29 CFR 1910.1000

Airborne Contaminants: Gasses (For each entry below that applies to operations at this location, confirm the potential hazard has been recognized, an ititial determination has been made based on chemical, physical and toxic properties of the contaminant, size of the workplace, amount and type of ventilation and proximity of the employee to the source of contamination? All operations identified as potentially hazardous have been sampled to assess the exposures using a typical exposure or a worst case scenario).

Gas furnaces or other combustion operations should be examined to determine the level of by products of combustion that may be released into the worktoom atmosphere.

Warehousing with PIT operation work areas should be checked for levels of carbon monoxide and oxides of nitrogen arising from the internal combustion engine fork-lift operations. Operations should also be evaluated for ergonomics hazards.

Heat and Cold Stress (complete if answered Yes to question 9g on pre-assessment questionnaire) ACGIH TLVs and BEIs

Extended work outdoors or in Hot or Cold work areas can cause exposue that can lead to heat or cold stess. Use a wetbulb globe thermometer to take environmental heat measurements.






Corrections Made


0 0


Occupational Health


Corrections Made


0.5

1

RAC 1RAC 2

RAC 3RAC 4

RAC 5

0 0

0 0

0

0 0 0

0 0


Version: June 2011


Asbestos Management and Exposure Prevention Enter "Y" or "N". If No,


applicable column

Enter Risk Assessment Code (RAC) Score 1-5 based on the DoD 6055.1 Protocol for Health

Hazards. (This code is to be used in prioritizing a sampling

strategy. The code can then adjusted based on assessment

findings).

Hazard Description: CHEM, BIO, PHY - along with a detailed

description of the operation and exposure location (Identify if

sampling is needed)



Action Completion

Date

Asbestos Is Not Present at the Installation (complete this sub-section)

29 CFR 1910.1001 & ASHRAE IAQ Quality GuidePotential sources of employee exposure to asbestos have been identified and surveys have been completed.

There is a written procedure in place that identifies the steps to report damaged asbestos containing materials so that they can be death with in a safe, timely manner

Documentation is available to confirm ACM never has been, or is no longer present in, or on, any of the existing buildings

A process is in place to monitor construction projects so that ACM will not be re-introduced to the installation

Asbestos Is Present at the Installation (complete if answered Yes to question 10a on pre-assessment questionnaire)A system is in place to ensure construction projects, including self-help projects, are monitored to ensure ACM is not "unknowingly" disturbed during construction activities

A process is in place to monitor construction projects so that ACM will not be re-introduced to the installation

Appropriate personnel (i.e., maintenance, housekeeping, carpenters, plumbers, etc.) have received minimum asbestos hazard awareness training as applicable

All pipes and materials identified as having asbestos in them must be labeled

An Asbestos Management Plan is in place

The Asbestos Management Plan is up to date

The Asbestos Management Plan contains appropriate signatures

A qualified person is identified. A qualified person is defined as one who is capable of identifying existing asbestos hazards in the workplace and who has the authority to take prompt corrective measures to eliminate them," but adds a specific training qualification. The training provisions require a competent person take a course which meets the requirements of EPA's Model Accreditation Plan (40 CFR 763, Subpart E)

General inventory of ACM is up to date - visual inspection of the facility coincides with the management plan (i.e., identified ACM is in place, ACM condition is consistent with descriptions in plans, etc.)

Response actions, details, and schedules for both emergency and planned remediation efforts are available for review

Operations & Maintenance plan is available for review

Abatement Design Specifications are available for review

Abatement air monitoring results are available for review

Abatement final clearance results are available for review

Personal exposure monitoring results are available for review

If asbestos is found to be crumbling, it is proper procedure to have it removed by a qualified trained individual and the area is appropriately blocked off

Asbestos Surveys (complete if answered Yes to question 10a on pre-assessment questionnaire)Sampling and analysis conducted according to AHERA (40 CFR 763 Subpart E) or generally accepted industry standards

Survey reports include appropriate interpretation of analysis results

Damage classification determination is completed

Disturbance evaluation is completed

Potential for worker exposure is identified

Potential for occupant exposure is identified






Corrections Made


0 0


Corrections Made


0.5

1

RAC 1RAC 2

RAC 3RAC 4

RAC 5

0 0

0 0

0

0 0 0

0 0


Version: June 2011




applicable column

Enter Risk Assessment Code (RAC)

Score 1-5 based on the DoD 6055.1

Protocol for Health

Hazard Description: CHEM, BIO, PHY - along with a detailed description of the

operation and exposure location (Identify if sampling is needed)



personal

Action Completion

Date

Process Safety Management, Emergency Response Plan, EPA Risk Management Plan (complete if answered Yes to question 11a on pre-assessment questionnaire)

29 CFR 1926.64 thru 65 The installation has a written PSM program and RMP program in place

All exceptions from the last PSM audit have been corrected

The installation has a written Emergency Response Plan in place

Identification of Piping Systems (complete if answered Yes to question 11a on pre-assessment questionnaire)All covered process piping is identified by tags constructed of durable materials, the message carried clearly and permanently distinguishable, and each valve is marked

Where pipeline contents are identified by abbreviations, this information is readily visible on the pipe near each valve or outlet

Haz-Mat Teams (complete if answered Yes to question 11a on pre-assessment questionnaire)The roster filed in the Emergency Response Plan is current with the last revision date annotated at the bottomHaz-Mat teams have received the appropriate training for their role

Fit test is completed at least annually on each haz-mat team member and the fit test is documented

All damaged or worn Haz-Mat Response Equipment is taken out of service and employees are aware of the proper procedure to turn in all damaged equipment

Properly Trained (complete if answered Yes to question 11a on pre-assessment questionnaire)Medical evaluations/ questionnaires are completed at least annuallyMonthly lessons/training is completed and documented. Each member has attended a minimum of two lessons per quarter

Haz-Mat Scenario drills are conducted quarterly

Initial certification and annual re-certification completed by each member

Haz-mat team members have been trained on proper respirator use

Haz-Mat Response Equipment (complete if answered Yes to question 11a on pre-assessment questionnaire)Maintained and stocked as specified on the Haz-Mat Inventory List

Air Purifying Respirators inspected and the inspection documented

Respirators are stored in a convenient, clean, and sanitary location

Respirators that are provided for emergency use, such as SCBAs are inspected at least once per month and after each use






Corrections Made


0 0

Process Safety Management


Corrections Made


0.2

0.4

0.6

0.8

1

RAC 1RAC 2

RAC 3RAC 4

RAC 5

0 0

0 0

0

0 0 0

0 0

INTERPERETIVE GUIDANCE DOCUMENT (IDG) Version: June 2011Environmental, Safety and Occupational Health Management systemDLA Strategic Materials

Version: June 2011

Ergonomics "N". If No,


applicable column

Enter Risk Assessment Code (RAC) Score 1-5 based on the DoD 6055 1

Hazard Description: CHEM, BIO, PHY - along with a detailed description of the

operation and exposure location (Identify if sampling is needed)

Required (Identify Specific


Action Completion

DateOSHA and NIOSH Guidelines

Program ERG-1 This location has a written ergonomics program.ERG-2 Job tasks are evaluated for Work-Related Musculoskeletal Risks (Repetition, force,

awkward posture)ERG-3 Employee are trained in techniques to minimize MSD risks (Lifting techniques,

workstation set-up, administrate controls)ERG-4 Administrative controls (Job/task rotation, etc.) are in place to limit employee exposure

to higher-risk tasksERG-5 Selected workstations are designed for adjustability to limit streching or awkward

postures for a range of workersERG-6 Mechanical aids are used where possible to limit strain, twisting, lifting forces, or other

stressors on workers.ERG-7 Workers do not lift objects weighing over 51 lbs alone. Heavy lifts are accomplished

with 2 or more people or by using a mechanical assist.ERG-8 Worker are educated on the signs and symptoms of MSDsERG-9 Ergonomically designed tools are utilized where possibleERG-10 Trending analysis is done to identify areas where MSD may be an issueERG-11 Working surfaces are adjustable too accomidate workers height where possible






Corrections Made


0 0



Corrections Made


0.2

0.4

0.6

0.8

1

RAC 1RAC 2

RAC 3RAC 4

RAC 5

0 0

0 0

0

0 0 0

0 0


Version: June 2011


Site Name:

Site Location:

Assessment Date:

Baseline % Score % Score after Corrections

1. Safety Management Program and Required Postings (MP) 0% 0%

2. Tools and Equipment and Lockout/Tagout (TE) 0% 0%

3. Walking and Working Surfaces and Confined Spaces (WW) 0% 0%

4. Personal Protective Equipment and Fall Protection (PPE) 0% 0%

5. Powered Industrial Trucks and Racking (PIT) 0% 0%

6. Trailer Control (TC) 0% 0%

7. Fire Protection and Fire Prevention (FS) 0% 0%

8. Life Safety and Emergency Procedures (LS) 0% 0%

9. Occupational Health (OH) 0% 0%

10. Asbestos Management and Exposure Prevention (ACM) 0% 0%

11. Process Safety Management (PSM) 0% 0%

12. Crane and Hoist (CRN) #REF! #REF!

13. Ergonomics (ERG) 0% 0%

Baseline Score %: #REF!Initial Number of Corrections Required: #REF!

Number of Corrections Made: #REF!Outstanding Corrections: #REF!

Score After Corrections Made: #REF!

Corrections Required Corrections Made

RAC 1 #REF! #REF!RAC 2 #REF! #REF!RAC 3 #REF! #REF!RAC 4 #REF! #REF!RAC 5 #REF! #REF!

#REF! #REF!

SECTION

SAFETY AND HEALTH BASELINE ASSESSMENT SUMMARY

Corrections Made


0

0

0

1

1

1

RAC 1 RAC 2 RAC 3 RAC 4 RAC 5

0 0 0 0 0 0 0 0 0 0

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